A health crisis and beyond

Invisible no longer

For many years, AIDS was referred to as the invisible
epidemic. HIV makes its silent way through a population for many years
before infections develop into symptomatic AIDS and become a cause of recurring
illness and, finally, death. The virus thus spread stealthily for years before
AIDS deaths were registered in any significant numbers.

In industrialized countries AIDS activists succeeded in raising
the profile of the epidemic early on. But in the developing world where most men
and women with HIV live, it is only now, two decades after the virus first
started spreading, that the repercussions of AIDS are stripping off its cloak of
invisibility.

In countries with mature epidemics - Uganda in East Africa,
Zambia and Zimbabwe in Southern Africa, for example - AIDS is leaving
highly-visible damage in its wake. Some doctors report that three-quarters of
beds on hospital paediatric wards are occupied by children ill from HIV.
Millions of adults have died. Most have left behind orphaned children. Many have
left surviving partners who are infected and in need of care. Their families
struggle to find money to pay for their funerals, and their employers must now
train other staff to replace them.

Wiping out the gains of
development

Together, the epidemics visible and less-visible
consequences constitute an urgent and massive threat to development.

Life expectancy crumbles

Life expectancy at birth is one of the key measures that
policy-makers look at to assess human development. Because of the extra deaths
from AIDS in children and young adults, this indicator is giving off alarm
signals. According to a just-released report prepared by the United Nations
Population Division in collaboration with UNAIDS and WHO, the epidemic will wipe
out precious development gains by slashing life expectancy.

The impact on life expectancy is proportional to the severity of
the local epidemic. In Botswana, for example, where more than 25% of adults are
infected, children born early next decade can expect to live just past their
40th birthday. Had AIDS not been in the picture, they could have
expected to live to the age of 70. Not surprisingly, between 1996 and 1997
Botswana dropped 26 places down the Human Development Index, a ranking of
countries that takes into account wealth, literacy and life expectancy.

Taking the nine countries with an adult HIV prevalence of 10% or
more (Botswana, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Zambia
and Zimbabwe), calculations show that AIDS will on average cost them 17 years of
life expectancy. Instead of rising and reaching 64 years by 2010-2015, a gain
which would be expected in the absence of AIDS, life expectancy will regress on
average to 47 years.

Deteriorating child survival

The dismal decline in life expectancy is due not only to deaths
of adults - most of them young or in early middle age - but also to child
deaths. HIV is contributing substantially to rising child mortality rates in
many areas of sub-Saharan Africa, reversing years of hard-won gains in child
survival.

By 2005-2010, for example, 61 of every 1000 infants born in
South Africa are expected to die before the age of one year. In the absence of
AIDS, infant mortality would have been as low as 38 per 1000. With AIDS in the
picture, the infant mortality rate in Namibia is projected to be 72 per 1000;
without the epidemic the country could have expected a far lower rate of 45 per
1000.

Children on the brink

Zimbabwe offers a frightening window onto orphanhood, another
aspect of the epidemics development impact. In this nation, where over a
quarter of the 5.5 million adults are HIV-infected, AIDS is already pushing
hundreds of thousands of children to the brink.

The government estimates that in two years time 2400
Zimbabweans a week will be dying of AIDS. Most of those deaths will be in
adults, and they will be concentrated in the young adult ages when people are
building up their families. What is more, they may be disproportionately
concentrated among single women whose death would leave a child with no parent
at all: one recent study in a farming area showed that single mothers, many of
them widowed by AIDS, were twice as likely to be HIV-infected as married women.

As early as 1992, a study in Zimbabwes third largest city,
Mutare, recorded that over 10% of children in the study area were orphaned, and
that nearly one household in five had taken in orphans. By 1995, an enumeration
in the same area showed that the proportion of children who were orphaned had
grown to nearly 15%.

The number of children in need of care is rising just as AIDS is
cutting into the number of intact families able to provide such care. Some 45%
of those caring for orphans are grandparents; often they have no income of their
own, and there is a limit to how many children they can take on without outside
help. One orphan-support programme reports helping an 80-year-old grandmother
who lives with 12 children in a single room. Another has received a request for
help from a widower with 9 dependants who has just inherited another 3
grandchildren to care for. A study of households headed by adolescents and
children (some as young as 11) showed that while the overwhelming majority had
lost both parents, most did have surviving relatives. However, in 88% of those
cases, the relatives reported that they did not want to care for the orphans.

Children themselves are beginning to worry about orphanhood and
to recognize the importance of supporting needy children. A majority of children
interviewed in one study said that if orphans needs were not met they
would become delinquent. Many said the children would drift into prostitution
and onto the streets. They also worried about abuse and exploitation of orphans
by relatives. With reason. Reports of sexual abuse of girls have risen rapidly
in recent years in Zimbabwe, prompting the establishment of a special clinic at
a major Harare hospital and an initiative to promote child-friendly courts. In a
single rural district of Zimbabwe one study recorded nearly 400 cases of child
sexual abuse, at least a quarter of them girls under the age of 12, and at least
10% of them orphans.

AIDS and business: the bottom line suffers

The onslaught of AIDS is denting the prospects for economic
development too. In the hard-hit countries of Africa, the epidemic is decimating
a limited pool of skilled workers and managers and eating away at the economy.
With many economies in the region in flux, it is hard to determine exactly what
the impact of HIV is on national economies as a whole. However, it is clear that
businesses are already beginning to suffer.

In Zimbabwe, for instance, life insurance premiums quadrupled in
just two years because of AIDS deaths. Some companies say that their health
bills have doubled. Several report that AIDS costs absorb as much as one-fifth
of company earnings. In Tanzania and Zambia, large companies have reported that
AIDS illness and death cost more than their total profits for the year. In
Botswana, companies estimate that AIDS-related costs will soar from under 1% of
the wage bill now to 5% in six years time, because of the rapid rise in
infection in the last few
years.